P3.13-029 Imaging Guideline-Recommendations Prior to Treatment for Non-Small Cell Lung Cancer Demonstrates Variable Compliance

Publication Title

Journal of Thoracic Oncology

Authors

J Rayburn
Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WashFollow
Christopher R Gilbert, Swedish Cancer Institute Seattle, WashingtonFollow
Brian Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Eric Vallieres, Division of Thoracic Surgery, Swedish Cancer InstituteFollow
Jed A Gorden, Swedish Cancer Institute Seattle, WashingtonFollow

Document Type

Conference Proceeding

Publication Date

11-1-2017

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Background

Poor adherence to the recommended guidelines in diagnosing and staging patients with non-small cell lung cancer (NSCLC), with negative downstream effects has been previously shown. In addition, studies have demonstrated benefits of staging with PET, including a reduction in number of non-curative resections performed and a higher rate of identifying M1b disease. Staging with brain MRI has demonstrated a yield up to 10% for detecting metastasis in patients with negative clinical examinations. We aimed to assess the adherence to imaging guidelines for PET and brain MRI in the staging of NSCLC patients prior to treatment within our healthcare system.

Method

We reviewed patients who underwent initial work-up for primary NSCLC during 6/2013–6/2015, in a hospital network of 7 institutions. Clinical stage II-IV patients were stratified by imaging performed prior to the initiation of treatment. Evidence-based clinical practice guidelines referenced include the American College of Chest Physicians (ACCP) 3rd edition and the National Comprehensive Cancer Network (NCCN) 7th version. Both ACCP and NCCN recommend a PET scan for suspected cIb-III; while ACCP recommends a brain MRI for suspected cIII-IV, and NCCN for suspected cIb-IV.

Result

The Fig demonstrates compliance rates for the 283 included patients. Of cII patients, 7% (2/30) did not receive a PET scan and 43% (13/30) did not receive a brain MRI; while, 11% (6/56) of cIII did not receive a PET scan and 20% (11/56) did not receive a brain MRI.

Conclusion

Variable compliance with imaging guidelines for the use of PET and brain MRI imaging for the staging of our NSCLC patients was seen. Lack of appropriate imaging for NSCLC staging may lead to inappropriate management decisions resulting from incomplete staging information. Quality initiatives are necessary to ensure guideline compliance.

Clinical Institute

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Pulmonary Medicine

DOI

10.1016/j.jtho.2017.09.1764